KEYWORDS:
workflow analysis, missed opportunity, immunization

BACKGROUND:
Interventions that have focused on provider behavior to improve missed opportunity rates have had minimal impact in improving either missed opportunity or coverage rates. Recent studies demonstrated only a marginal relationship between individual physician knowledge and beliefs compared to the physician's rates for missed opportunities. There may be more complex interactions occurring that need to include clinic operational functions.

OBJECTIVE(S):
To determine if there are clinic operational conditions that affect the likelihood that a child will receive needed immunizations.

METHOD(S):
Workflow analysis of clinic and immunization practices was performed using a standardized, published tool. Data recorded included chart availability, time sequence, shots ordered vs. shots administered, patient eligibility for immunization. Regression analysis was performed to look for correlation between factors.

RESULT(S):
Visit scheduling, staff-to-patient ratios, availability of charts, and time to complete clinical tasks all had significant impact on the likelihood a child would receive a vaccination for which they are eligible.

CONCLUSIONS(S):
Operational conditions are at least as important to consider as provider and patient characteristics in improving immunization rates.

LEARNING OBJECTIVES:
Understand how activities such as scheduling patients, staffing ratios, "walk-in" policies, and chart availability impact the delivery of immunizations.